Dual Implementation Guides in FHIR and CDA.

BACKGROUND: The Fast Healthcare Interoperability Resources (FHIR) and Clinical Document Architecture (CDA) are standards for the healthcare industry, designed to improve the exchange of health data by interoperability. Both standards are constrained through what are known as Implementation Guides (IG) for specific use. OBJECTIVES: Both of these two standards are widely in use and play an important role in the Austrian healthcare system. Concepts existing in CDA and FHIR must be aligned between both standards. METHODS: Many existing approaches are presented and discussed, none are fully suited to the needs in Austria. RESULTS: The IG Publisher has already been used for CDA IGs, beside of its intended FHIR support, but never for both in one IG. Even the International Patient Summary (IPS), existing as CDA and FHIR specification, does not solve the needed comparability between these two. CONCLUSION: As the IG Publisher is widely used and supports CDA, it should be used for Dual Implementation Guides. Further work and extension of IG Publisher is necessary to enhance the readability of the resulting IGs.

ELGA Outpatient Clinic Report and ELGA Telehealth Note: Two HL7-CDA®-Based Modular Electronic Documents.

BACKGROUND: From 2022, the "Outpatient Clinic Report" and the "Telehealth Note" will complement the existing e-Reports in the Austrian Electronic Health Record system ELGA. OBJECTIVES: The specification of two harmonized implementation guides with standardized structure for all types of outpatient clinics in hospitals on the one hand and for telemonitoring treatments on the other hand. METHODS: With the participation of expert groups, the contents were harmonized, and a data model was created. Template specifications were modelled in ART-DECOR and approved in the course of an HL7 Austria ballot. RESULTS: Two sets of freely selectable building blocks and machine-readable content were created. CONCLUSION: The "Outpatient Clinic Report" and the "Telehealth Note" are currently being implemented. The use of these documents will be evaluated as well as if additional machine-readable content is needed.

TerminoloGit - An Open Source Terminology Server for Large Scale eHealth Environments.

Semantic interoperability is the centerpiece of successful communication between information systems within the health care system. As such, a terminology server provides information systems with the concepts needed for coding information accordingly. As the current Austrian terminology server does not meet all requirements anymore, a new terminology server is necessary. Consequently, after an unsuccessful call for bids, the Semantic Competence Center (SCC) of the ELGA GmbH set up a technologically more advanced solution for a new terminology server. The result is a Git based architecture in combination with the HL7® FHIR® IG publisher complemented by a FHIR® server and some in-house developments. The Git repository is hosted on GitLab.com, hence, allowing the use of GitLab's CI/CD functionalities for publishing the contents. Since the 1 January 2022 the new terminology server "TerminoloGit" is operational and provides 171 code lists and 141 value sets. Using open-source components only and making all parts of the system publicly available results in a cost-effective solution which may also be improved by the open-source community.

Challenges of a HL7 CDA Guideline for Telehealth Based DMP Systems.

BACKGROUND: Disease management programs (DMP) are a modern way of treating health conditions and are becoming a part of standard care. One telehealth DMP service has been in regular operation since 2017, named "HerzMobil Tirol". OBJECTIVES: This paper investigates, if the electronic health record standard HL7 CDA, which is widely accepted in the health care industry, could be used for telehealth DMP services as well. It is already in use in a legally required integrated element of healthcare in Austria called ELGA. An official guideline from the Austrian Ministry of Health sets the standard for telemonitoring with data logging. METHODS: After the background knowledge was built up, requirements have been gathered through existing official guidelines and interviews and existing documentation by "HerzMobil Tirol". RESULTS: Twenty-five requirements were collected, categorized and analyzed to determine if the existing CDA guidelines are suitable or a new standard must be designed. CONCLUSION: Based on the requirements, it was established that seven specific sections and two different CDA documents are needed.